Provider Demographics
NPI:1487995825
Name:DESAI, DARSHNA KETANKUMAR
Entity type:Individual
Prefix:
First Name:DARSHNA
Middle Name:KETANKUMAR
Last Name:DESAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 1ST ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1902
Mailing Address - Country:US
Mailing Address - Phone:941-746-9259
Mailing Address - Fax:941-744-0259
Practice Address - Street 1:520 1ST ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1902
Practice Address - Country:US
Practice Address - Phone:941-746-9259
Practice Address - Fax:941-744-0259
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234271183500000X
FLPS56693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist